The development and pandemic-related adaptation of a resilience program for native middle-school youth: A case study.

BACKGROUND: As of 2017, American Indian/Alaska Natives (AI/AN) had the highest prevalence of illicit drug use of any ethnic group in the United States, with 17.6% of the population aged 12 and older reporting using illicit drugs in the last month. Studies have shown the positive correlation between a history of trauma and substance use disorder. In fact, the majority of youth in treatment for substance misuse reported a history of trauma. Intergenerational trauma, systematic discrimination, and displacement are downstream effects of colonization, and experiences of racism often define the life experiences of AI/ANs who use substances. This paper describes the process of designing a developmentally and culturally appropriate primary prevention supplement for an evidence-based program to prevent substance use and increase cultural identity among AI/AN youth.

Factors That Influence Quality of Life in People Experiencing Homelessness: A Systematic Mixed Studies Review.

BACKGROUND: An emerging category of morbidity in research among people experiencing homelessness (PEH) is quality of life (QoL). The Commission on Social Determinants of Health (CSDH) framework was used to explain the relationship between the resulting factors and their impact on QoL among PEH. AIMS: The purpose of this systematic mixed studies review was to explore the factors that are associated with QoL among homeless individuals. METHOD: A systematic mixed studies review was conducted using CINAHL, Medline, PubMed, and SocIndex databases. Quantitative, qualitative, and mixed methods studies were included and synthesized employing results-based convergent synthesis design. RESULTS: The initial search resulted in 757 studies with 55 studies meeting the inclusion criteria. Thematic analysis revealed themes influencing QoL among PEH categorized by the CSDH determinants of structural, social cohesion and social capital, and intermediary determinants. Among these themes, higher social status, strong relationships, better reported physical and mental health, and a positive life outlook were associated with increased QoL. Social isolation, substance use, poorer life outlook, increased years spent homeless, and perceived quality of housing were associated with decreased QoL. Age, sex, and housing programs revealed inconsistent results on QoL. CONCLUSIONS: While the factors presented in this review indicate some consistent relationships with QoL in PEH, this review has shown QoL among this population is complex and multifactorial. Future research should focus on relationships between the CSDH determinants, particularly the psychosocial factors and the QoL priorities defined by PEH, and how they may influence QoL among PEH.

Factors That Influence Substance Use Among American Indian/Alaskan Native Youth: A Systematic Mixed Studies Review.

BACKGROUND: The American Indian/Alaskan Native (AI/AN) mortality rate from illicit drug use was 22.7%, double that of the general population between 2007 and 2009. Fifteen percent of AI/AN youth reported receiving treatment for substance use compared with 10% of non-AI/AN peers. OBJECTIVE: The purpose was to explore the factors that influence substance use among AI/AN youth. METHOD: We performed a systematic review using a results-based convergent synthesis design. Eight electronic databases were searched for articles published between 2014 and 2019 using the search terms "Native American youth," "Native American adolescent," "Native Youth," "substance use," "substance misuse," and "substance abuse." The Mixed Methods Appraisal Tool was used to appraise the studies. RESULTS: Forty-seven studies met the inclusion criteria (44 quantitative, one qualitative, and two mixed-methods studies). The results were organized using the ecological systems model and included evaluation of both protective and risk factors related to AI/AN youth substance use. Three system levels were found to influence substance use: individual, micro- and macrosystems. The individual systems-level coping mechanisms played a key role in whether AI/AN youth initiated substance use. Family, school, and peer factors influence the microsystem level. At the macrosystem level, community environmental factors were influential. CONCLUSION: The major factor linking all the systems was the influence of a connected relationship with a prosocial adult who instilled future aspirations and a positive cultural identity. Findings of this systematic mixed studies review will assist in intervention development for AI/AN youth to prevent substance misuse.

A Mixed-Studies Review of the School-to-Prison Pipeline and a Call to Action for School Nurses.

Zero-tolerance school disciplinary policies have contributed to the proliferation of exclusionary practices, which increase the risk that minoritized students will be harmed by the school-to-prison pipeline (STPP). The purpose of this review was to explore factors that influence the STPP and highlight the role school nurses can play in protecting students from this public health crisis. We used a systematic mixed-studies review method, and 14 studies were included. Exclusionary discipline disproportionately affects minoritized students, but decreased student-teacher ratios, wellness-focused environments, and lower levels of school punishment can improve student achievement and health. The National Association of School Nurses position statement provides a framework to guide school nurses in the dismantlement of the STPP. School nurses should advocate for their position on the interdisciplinary team, funding for alternative disciplinary programs, abolition of school policing, restorative justice approaches, support for at-risk students, and anti-racism education programs for all school staff.

HPV Vaccination and Korean American College Women: Cultural Factors, Knowledge, and Attitudes in Cervical Cancer Prevention.

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection that leads to nearly all cervical cancers in the United States (U.S.), which could be prevented with the HPV vaccine. Korean American women experience a high burden of cervical cancer, but little is known about their awareness, knowledge, attitudes, sociocultural factors and social network/support related to intention to obtain the HPV vaccine. This study reports baseline characteristics of 104 Korean American college women aged 18-26 and who have not been previously vaccinated against HPV, as part of a pilot randomized controlled trial testing feasibility, acceptability, and preliminary effectiveness of an HPV storytelling intervention. Data were analyzed including descriptive statistics, bivariate analysis, and multivariate logistic regression. Multivariate logistic regression was performed to understand the relationship between independent predictors of intention to receive HPV vaccination. Overall, 34.6% of participants intended to obtain the vaccine. Positive predictors of intention to receive HPV vaccine were: years in the U.S., academic major, awareness of HPV and HPV vaccine, knowledge, and HPV recommendation by healthcare provider and parents. The multivariate logistic model showed that intention to receive the HPV vaccine was significantly associated with HPV vaccine recommendation by parents (OR 4.58, 95% CI 1.37-15.36) and knowledge (OR 1.11, 95% CI 1.11-1.22). These findings suggest a need for development of interventions that are not only culturally tailored but also acculturation-sensitive to promote HPV vaccination among Korean American college women. This may play a significant role in cervical cancer prevention among Korean American college women.

Invisible Minority: HIV Prevention Health Policy for the Asian American Population.

There has been a 72% increase in the Asian American population from approximately 12 million in 2000 to 21 million in 2015. By 2050, there will be 33.4 million Asian Americans living in the United States, making this population the most rapidly growing ethnic group in the country. There is a myth that Asian Americans are a model conservative minority group in terms of sexual behavior and safe sexual practices and are not at risk of sexually transmitted infections including HIV. However, they are the only ethnic group in the United States that had a continuous increase in HIV infection rates from 4.9 per 100,000 in 2011 to 5.5 per 100,000 in 2016. Due to state and national methods of data collection for race and ethnicity with regard to sexually transmitted infection and HIV, the Asian American population's data are often limited. The purpose of this article is to identify the potential historical and political reasons why the Asian American population's HIV or sexual risk has not been fully documented and to propose potential health policy solutions.

Engaging college students in a substance misuse & sexual health intervention using social marketing principles.

BACKGROUND/PURPOSE: The successful recruitment and retention of participants is integral to the translation of research findings. Recruitment begins once you have defined your focus population and identified where and how to reach them (i.e., targeting). Formative evaluation can provide valuable information on recruitment, given the dynamics of different communities and the potential for certain strategies to work better than others with high-risk groups. The preliminary work of engaging the population of interest is essential to successfully attracting and retaining the involvement of populations of interest. The purpose of this paper is to present methods used to engage college students in a multi-level intervention aimed at preventing substance abuse, HIV and STIs. THEORETICAL FRAMEWORK: Andreasen's six principles of social marketing were used to develop intervention activities and engage students in these activities. METHODS: A multi-method approach was employed using both survey and focus groups for preliminary feedback, post-event surveys and annual evaluations. RESULTS: Pamphlets are not enough to attract potential participants because advertisements need to be engaging and employ social networking sites. Students also enjoy playing both on-line and in person games and are quite competitive. Testing for HIV tripled in the first year. CONCLUSIONS & IMPLICATIONS: Students became more aware with each subsequent event participation increased over time. Although word of mouth is still very effective in getting students to events, the use of social networking sites greatly improved student participation.

Sexual communication intervention for African American mothers & daughters.

BACKGROUND: African American girls ages 13-19 comprised nearly 3 out of 4 new cases of HIV in 2009. The goal of this study was to deliver a theoretically-driven intervention to test the feasibility for recruitment and retention of mother-daughter dyads. METHODS: Twenty mother-daughter dyads were recruited from a community health center between February-April 2014. Comparisons were made between pre- and post-intervention scores using percent change. RESULTS: Twelve dyads (60%) completed the intervention. There were no demographic differences between completers and noncompleters. Notable post-intervention percent increases in scores were observed in the domains: Sexual knowledge (15%), confidence to talk (23.2%); and openness of sexual communication (26.4%). CONCLUSION: Our small-sized study showed promise in the intervention. Increasing sexual communication between African American mothers and daughters is likely to be sustainable over time and across relationships, and thus have a greater impact on HIV-prevention behaviors later in life.

Recognizing global disparities in health and in health transitions in the 21st century: what can nurses do?

PURPOSE: To examine changes in patterns of health and disease in global context between rich countries (USA, Korea, South Africa) and poor countries (Cambodia, Malawi) by using the framework of epidemiology theory developed by Orman (1971, 2005), and to raise awareness of global health disparities thereby prompting actions to reduce such disparities. FINDINGS: 1) Life expectancy has increased across all selected countries except South Africa; 2) Korea and the USA have substantially lower mortality rates than other countries; 3) Infant and maternal mortality are still high in the poor countries; 4) The major cause of mortality in the poor countries is still communicable disease with evidence of the onset of non-communicable disease; and 5) The health transition theory provides a description and explanation of the differences in progress in economic development between countries but fails to explain differences in health status within and between countries. CONCLUSIONS: Life expectancy and mortality are enormously different among the five selected countries. This excessive health disparity is primarily due to the higher risk of communicable diseases in low-income countries. Social determinants of health are mainly responsible for the health disparities observed within and between countries. CLINICAL RELEVANCE: Future health care development and global research priorities will not be the same for all countries because the pattern of health transitions in the developing countries is not the same as the developed countries. Actions to reduce global health disparities need to recognize the conditions and social context in which persons live. An effective strategic approach to global health equality should develop a shared system of values, priorities, and delivery infrastructures with the populations who are targeted, aligning delivery within the local social contexts.

Factors that influence Asian American college students use of mental health services: A systematic mixed studies review.

WHAT IS KNOWN ON THE SUBJECT?: Only 8.6% Asian Americans (AAs) report seeking mental health services compared to nearly 18% of the general population. There is a stigma against seeking mental health services among AAs. Mental illness is thought to be caused by a lack of harmony of emotions or evil spirits leading to delay in treatment among AAs. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Asian students are hesitant to use mental health services because they are balancing their desire to be part of the two cultures. Concepts used to define culture were found to have overlapping aspects of how researchers operationally define them, and few studies examined a combination of these concepts as a means of examining interactions between the concepts. AA emerging adults feel pressure through personal stigma from elders to 'save face' by keeping their problems to themselves or within the family to maintain a positive reputation for the family. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overlap of conceptual definitions to understand cultural beliefs and values affecting measurement have complicated the interpretation of the research. Future research should include a multidimensional operationalization of culture that includes acculturation, ethnic identity, personal stigma and their effect on mental health help-seeking attitudes. Differences between South Asian and East Asian philosophical and cultural perspectives could influence access to mental health services; therefore, future studies should consider sampling that would allow for comparison of the groups. Understanding the factors that influence mental health help-seeking behaviours can determine intervention strategies to improve AA emerging adult mental health. ABSTRACT: INTRODUCTION: Only 8.6% of Asian Americans (AA) sought mental health services compared to 18% of United States population. AA college students report higher levels of mental health concerns compared to White students. AIM: The purpose of this systematic review was to identify the factors that influence AA students' mental health help-seeking behaviours. METHOD: Employing a data-based convergent synthesis design. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the sample. Inclusion criteria were peer-reviewed studies published in English, focused on AA college students' mental health seeking attitudes in United States. RESULTS: The final sample was forty-four studies. Four themes emerged: acculturation, ethnic identity, racism and stigma. There were discrepant findings regarding how acculturation affects mental health help-seeking attitudes. Several studies included more than one theme in their analyses. The different concepts included across studies make it difficult to compare the findings. DISCUSSION: There is some overlap between acculturation and ethnic identity that could affect the analysis in studies where both concepts are included. Personal stigma negatively influences mental health help-seeking attitudes. IMPLICATIONS FOR PRACTICE: Defining culture to include acculturation, ethnic identity, personal stigma can help in understanding their effect on mental health help-seeking attitudes.

Trauma-Informed Research With Emerging Adult Survivors of Sexual Violence.

Health researchers have had increasing calls to include vulnerable populations in research to tailor inclusive evidence-based practice interventions. The inclusion of vulnerable populations in research is sensitive and complex. Sensitive topics such as dating and sexual violence are especially complex, with emerging adults the highest risk group for all forms of sexual violence and an especially hard-to-reach population for inclusion in research. Impacts of trauma, including physiological and psychological, complex needs of survivors, and potential for revictimization during interactions when participating in research must be considered. Researchers must be equipped with specialized, trauma-informed skills to safely and ethically conduct all aspects of research. Using the trauma-informed framework, the purpose of this paper is to discuss the complexities of conducting research with emerging adult survivors of sexual violence and to explore evidence-based approaches that can safely include this vulnerable population through the application of trauma-informed approaches. The use of evidence-based, trauma-informed research approaches tailored to engage this population in research can further help to develop effective interventions that are context-sensitive to emerging adults.

Parenting strategies African American mothers employ to decrease sexual risk behaviors in their early adolescent daughters.

OBJECTIVE: The impact of parenting strategies on adolescent's behavior has been the focus of research in the past three decades; the findings have never been more critical, particularly among African American mothers. According to the World Health Organization, approximately 70% of all new HIV cases are among female African Americans (AA) aged 15-24 years. The purpose of this study is to explore the process by which AA mothers intervene with their early adolescent daughters to decrease risky sexual situations, with the long-term goal of HIV prevention. DESIGN AND SAMPLE: A total of 64 AA mother-daughter dyads were recruited and separate focus groups were conducted for mothers and daughters with 6-8 per group. METHOD: Focus group methodology with principles of participatory action research was employed to formulate focus group questions, recruit dyads, and to analyze the data. RESULTS: Five codes emerged: scaring, limit setting, monitoring, nurturing/instilling values and identifying with one's ethnicity. The findings also showed an interaction between neighborhood risks, mother-daughter relationships and parenting strategies. CONCLUSIONS: Parenting strategies could be targeted for public health prevention interventions with the long-term goal of HIV prevention.

The Role Nurses Can Play in Addressing and Preventing the Prevalence of Missing or Murdered Indigenous Women and Girls (MMIWG).

INTRODUCTION: In 2016, 5,712 American Indian/Alaskan Native (AI/AN) women and girls were reported missing in the United States. In Canada, 4% of the population is Indigenous, yet Indigenous females represent 50% of all sex trafficking victims. This systematic mixed-studies review examined the effects of Missing and Murdered Indigenous Women and Girls (MMIWG) to define a role for nurses. METHODS: We used five databases with keywords, inclusion criteria, and the Mixed Methods Appraisal Tool. RESULTS: Findings of 22 papers discuss: (a) demographic data; (b) factors that increase vulnerability of AI/AN women; and (c) how nurses can decrease the prevalence of MMIW. DISCUSSION: Nurses are the first provider patients see when accessing care. Increasing knowledge about the impact of violence against AI/AN women and girls is the first step in identifying measures needed to address this public health concern.

Facilitating diversity of thought in learning environments for nursing students.

Human capital development is one of the goals of higher education and a decrease in open dialogue threatens these ideals and aspirations. A recent survey of undergraduate students showed that many students censor their point of view. There are many potential reasons for this, but it could be secondary to the current sociopolitical climate. Having educators who encourage and model open dialogue while supporting diversity of thought would provide alternative perspectives and innovation. Encouraging diversity of thought will enhance understanding of other's perspectives and unleash creative problem solving to address concerns in nursing practice and facilitate innovative research. The purpose of this article is to present strategies that can be employed to promote diversity of thought among nursing students in a learning environment. Exemplars are presented illustrating some of the strategies discussed.

The role of rape myth acceptance in the social norms regarding sexual behavior among college students.

This study examined the antecedents for the acceptance of rape myths. The information motivation behavioral skills model was the basis for this study. In this cross-sectional study at a northeastern university, 237 students consented to participate in an online survey examining knowledge, social norms regarding sexual behavior, future time perspective, and rape myth acceptance (RMA). The majority of the sample was female. Forty-one percent believed that a woman who was raped while drunk was responsible. Men had higher RMA and the less sexual knowledge they had, the more they accepted the rape myths. Direction is provided regarding primary prevention of sexual assault.

Psychological Distress and Work-Related Quality of Life Among Oncology Nurses During the COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND: Oncology nurses are at disproportionate risk for psychological distress because they often encounter ethical challenges and deaths while providing care. Exposures to emergent suffering during the COVID-19 pandemic compound their chronic distress, which likely increased their vulnerability to psychological distress and may increase their risk for reduced work-related quality of life (WRQOL). OBJECTIVES: This study examined the association between psychological distress and WRQOL among oncology nurses during the COVID-19 pandemic. METHODS: A cross-sectional analysis of psychological distress and WRQOL among oncology nurses (N = 63) was conducted. FINDINGS: The mean Depression, Anxiety and Stress Scale score was 33.4, showing low depression levels, mild anxiety, and mild stress. The mean PTSD score was 29.3, and the mean WRQOL Scale score was 78.8. Depression, anxiety, and stress were strongly correlated to PTSD, and WRQOL was negatively correlated to PTSD, depression, anxiety, and stress.

The impact of patient-centred care on the relationship between access to care and subjective health outcomes amongst people experiencing homelessness: A mediation analysis.

People experiencing homelessness (PEH) have stated that impersonal care and feelings of discrimination are barriers to accessing healthcare which is associated with poor health outcomes amongst PEH. This study examined whether patient-centred care (PCC) mediates the relationship between access to care and subjective health outcomes. Using the 2014-15 Healthcare Center Patient Survey, we identified 1873 homeless and vulnerably housed adults. Items related to the delay or inability to receive primary or mental healthcare, PCC provided by healthcare providers, general health status, and the Kessler-6 psychological distress scale were selected. Ordinary least squares analyses were used to perform mediation analysis. We found that both access to primary care and access to mental healthcare were positively associated with physical health status (ß = 0.492, p < 0.001; ß = 0.311, p < 0.001) and negatively associated with psychological distress (ß = -2.53, p < 0.001; ß = -1.85, p < 0.001). PCC partially mediated all associations, but the mediation was stronger in the relationships between access to primary care and health outcomes (ab = 0.25, 95% CI [0.002, 0.052]; ab = -0.21, 95% CI [-0.37, -0.07]) compared to mental healthcare (ab = 0.02, 95% CI [0.01, 0.04]; ab = -0.14, 95% CI [-0.25, -0.06]). The results of this study indicated access to primary and mental healthcare is important in the patient-centred health outcomes of PEH. Additionally, the partial mediation of PCC in these relationships indicated that participants' perception of collaborative, trustworthy, respectful care from healthcare providers impacted the relationship between access to healthcare and health outcomes.

Homelessness and Vulnerably-Housed Defined: A Synthesis of the Literature.

There is no single accepted definition used in policy or research for the concepts of homelessness and vulnerably housed. Neuman's systems model (NSM) was the framework for this mixed-studies review, with the client system defined as these social issues and categorized as environmental stressors. Eighteen unique definitions of the concepts were identified in 30 studies. Extrapersonal stressors included housing history, interpersonal stressors included dependence on others for housing, and intrapersonal stressors included self-identification. Each level of stressor should be considered when defining these populations for inclusion in future research. Proposed definitions were formulated from the analysis of the results.

A Systematic Mixed-Studies Review of Hope Experiences in Parents of Children With Cancer.

BACKGROUND: Hope is negatively associated with parental psychosocial distress and psychological maladjustment as well as an important aspect of emotional well-being and coping for adults with cancer and their caregivers. Yet, little is known about hope experiences of parents of children with cancer. OBJECTIVE: The aim of this study was to comprehensively describe hope experiences in parents of children with cancer using a systematic mixed-studies review. INTERVENTION/METHODS: Psych INFO, PubMed, Academic Search Premier, and CINAHL databases were used to retrieve articles published in English between January 2005 and October 2019. Using the systematic mixed-studies review convergent design, qualitative and quantitative data were collected and extracted followed by qualitative synthesis. Seventeen articles met the inclusion criteria. Exclusion criteria were systematic reviews, nonresearch articles, case reports, and abstracts. RESULTS: Hope is a fundamental source of strength and inner guidance for parents. Findings suggest that hope is negatively correlated with parental psychological distress symptoms and coping dysfunctions. Religiosity, spirituality, and adequate provider-parent communication may strengthen hope in parents. CONCLUSION: Parental hope may help minimize psychological distress and maladjustment after a child's cancer diagnosis. Open communication channels between providers and parents are critical in preserving hope. An understanding of religiosity, spirituality, optimism, and sociodemographic variables may inform parental psychosocial interventions. IMPLICATIONS FOR PRACTICE: Early identification of parents with psychological distress is critical as they may struggle more in the absence of hope. Targeted psychosocial interventions may help parents of children with cancer cope better. Ongoing assessments of spiritual needs may be important in sustaining hope.